What can I do if my current medication for vertigo (dizziness) is no longer effective?

Management of Ineffective Vertigo Medication

If your current medication for vertigo is no longer working properly, you should seek evaluation for canalith repositioning procedures (CRPs) rather than continuing with medication therapy, as CRPs have success rates of 80-96% with just 1-3 treatments. 1

Understanding Your Vertigo

Vertigo is not a disease itself but a symptom that can have several causes. When medications stop working, it's important to:

1. Identify the specific type of vertigo you have
2. Consider non-medication approaches that are more effective

Most Likely Diagnosis: Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common cause of vertigo and is characterized by:

• Brief episodes triggered by head position changes
• Sensation of spinning or movement
• Symptoms that worsen with certain head positions

First-Line Treatment Recommendation

Canalith Repositioning Procedures (CRPs)

• These procedures are designed to guide displaced crystals back to their original location in your inner ear 2
• Success rates are around 80% with only 1-3 treatments 2
• The Epley maneuver has a 90.7% success rate after initial treatment, increasing to 96% after a second attempt 1

Avoid Relying on Medications

• The American Academy of Otolaryngology-Head and Neck Surgery recommends against routinely treating BPPV with vestibular suppressant medications such as antihistamines and benzodiazepines 2
• These medications:
  • May mask symptoms without treating the underlying cause
  • Can have unwanted side effects
  • May interfere with the brain's natural compensation process 1

Next Steps

1. Seek professional evaluation: Visit a healthcare provider (medical provider, audiologist, or therapist) who can perform proper diagnostic tests and appropriate repositioning maneuvers 2

2. Diagnostic confirmation: The provider should perform tests such as the Dix-Hallpike test for posterior canal BPPV or the supine roll test for horizontal canal BPPV 1

3. Specific treatment based on BPPV type:

   • Posterior canal BPPV: Epley maneuver (90.7-96% success rate)
   • Lateral canal BPPV: Barbecue Roll Maneuver (75-90% effectiveness) or Gufoni Maneuver (93% success rate) 1

Follow-up Care

• You should be reassessed within 1 month after treatment to document resolution or persistence of symptoms 2
• Even after successful treatment, you may feel slightly unsteady for a few days to weeks as your body adjusts 2
• If symptoms persist after initial treatment, additional repositioning sessions may be needed 2

Important Considerations

• BPPV can sometimes return (recurrence rate of approximately 36% within the first year) 1
• If repositioning maneuvers don't help, you may have a different type of vertigo that requires alternative treatment
• For persistent balance issues after BPPV resolution, vestibular rehabilitation exercises may be beneficial 2, 1

Caution

• Take precautions to prevent falls while experiencing vertigo symptoms
• Seniors with a history of falls or fear of falling may need additional balance therapy even after BPPV is treated 2

Remember that while medications may temporarily reduce symptoms, they don't address the underlying cause of most vertigo cases, particularly BPPV. Repositioning maneuvers are the most effective treatment with minimal side effects.